topiramate and Delirium

We report about a patient (66 years) who was referred to our psychiatric hospital because of a progressive confusional state with acute onset. The colleagues of the referring psychiatric hospital considered a first manic episode as the cause of the symptoms and under therapy with haloperidol the confusional state had shown a progression.The clinical examination's findings were a mild central facial paresis on the right side and a mild hemiparesis on the right side with elevated reflex levels.The patient was disoriented, he had cognitive and mnestic deficits. His reasoning was slowed, incoherent and perseverating. The patient had a slight euphoria.An EEG recording showed a continuous regional EEG-seizure pattern. In combination with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment with Topiramate symptoms ameliorated but due to a vascular dementia the patient still showed fluctuating symptoms of cognitive and mnestic disturbances.

Topics: Affect; Aged; Anticonvulsants; Antipsychotic Agents; Brain Edema; Confusion; Delirium; Dibenzothiazepines; Drug Substitution; Drug Therapy, Combination; Electroencephalography; Frontal Lobe; Fructose; Humans; Lorazepam; Magnetic Resonance Imaging; Male; Mental Status Schedule; Neurologic Examination; Quetiapine Fumarate; Referral and Consultation; Signal Processing, Computer-Assisted; Status Epilepticus; Topiramate; Valproic Acid